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Support Overdue: Women’S Experiences of Maternity Services May 2013 the Nfwi and Nct

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Support Overdue: Women’S Experiences of Maternity Services May 2013 the Nfwi and Nct SUPPORT OVERDUE: Women’S EXPERIENCES OF MATERNITY SERVICES May 2013 THE NFWI AND NCT THE NFWI • popular and trusted website, which THE NFWI 2013 The National Federation of Women’s two million people visit each year Author: Gabrielle Bourke Institutes (NFWI) is an educational, • national telephone helpline social, non-party political and • evidence-based research The National Federation of non-sectarian organisation. It was • effective influencing activity. Women’s Institutes (NFWI) established to ensure that women 104 New Kings Road are able to take an effective part in Our achievements include London, their community, to learn together, campaigning to allow fathers into SW6 4LY widen their horizons, improve and the delivery room; the labelling Tel: 020 7371 9300 develop the quality of their lives and then banning of Bisphenol A in and those of their communities and baby bottles; reducing unnecessary www.theWI.org.uk together influence local, national and interventions such as induction, international affairs on issues that episiotomies and enemas during NFWI-Wales matter to members. childbirth; establishing the Healthy 19 Cathedral Road Start Scheme; influencing the Cardiff, CF11 9HA The NFWI is the largest women’s Equality Act in Britain and the Tel: 02920 221 712 organisation in the UK with some Breastfeeding etc. (Scotland) Act 212,000 members in 6,500 Women’s 2005 to protect women breastfeeding Incorporated in England & Wales as a company Institutes across England, Wales and in public. Limited by Guarantee – the Islands. The NFWI has a long No. 251 7690 history of undertaking educational As a charity, we rely on our 5,000 work and campaigning on a diverse volunteers and our 100,000 members Charity Registration No. 803793 range of issues. The first NFWI – for their time, passion, and mandate was passed in 1918, donations. and since then the organisation has accumulated a wide-ranging ACKNOWLEDGMENTS portfolio of policy concerns on a Thank you to the following for making local, national and international this publication possible. level. The NFWI resolution process means that members play a central Thank you to the many women, role in defining policy and bringing including WI and NCT members, who issues onto the organisation’s shared their experiences and have national agenda. generously allowed us to tell their stories here. NCT We’re here for all new parents during The NHS trusts in England and boards their First 1,000 Days – from the in Wales who shared their information start of pregnancy until their child’s with us and especially the many second birthday. Evidence shows that FOI officers for their patience and how parents cope during this time understanding when dealing with our is absolutely critical to what kind of requests for information. adult each child grows into. The research advisory group: Established in 1956, we help parents Susan Baines, President of Horwich through our: WI, Lancashire Federation; Elizabeth • supportive UK-wide network of 320 Duff, Senior Policy Adviser, NCT; branches Jacque Gerrard, Director for England, • locally-delivered professional courses RCM; and Rachel Barber, Head of to 80,000 new parents each year Public Affairs, NFWI. Support Overdue: Women’s experiences of maternity services – Page 2 CONTENTS List of figures and tables 4 Foreword 6 Executive summary 7 Introduction 12 Research methodology 15 FINDINGS Missing midwives – workforce challenges 17 My midwife and me – the relationship between women and their midwives 36 Decisions and obstacles – choosing where to give birth 59 Continuing care – postnatal care 83 Conclusion 94 References 97 Glossary 106 Support Overdue: Women’s experiences of maternity services – Page 3 LIST OF FIGURES AND TABLES MISSING MIDWIVES – WORKFORCE CHALLENGES Page Figure 1 Percentage change in number of maternities 2002 to 2011 by regions of England and Wales 19 Figure 2 Age profile of midwives: Yorkshire, West Midlands, South Central, East and North East LSA reports 2011-12 22 Figure 3 Midwives vs births 2002-11 23 Figure 4 Ratio of midwives to births in England and Wales 24 Figure 5 How many midwives does England need? 25 Figure 6 How many midwives does Wales need? 26 Figure 7 Births per 1 WTE midwife by region, 2001-11 27 Table 1 Midwife to births ratios supplied by trusts and boards 29 Table 2 Trusts and boards responses to births to midwife ratio question 30 Figure 8 Percentage difference in midwifery WTE of trusts/boards, 1 May 2011 vs 1 May 2012 31 MY MIDWIFE ANd me – The relatiONSHIP BEtwEEN WOMEN AND THEIR MIDWIVES Page Table 1 Responses by trusts and boards to allocated midwife 38 Figure 1 Responses to survey question on ‘allocated midwife’ 39 Figure 2 Allocated midwife by region 39 Figure 3 Knowing your midwife 42 Table 2 Knowing your midwife, by location 42 Table 3 Impact of not knowing your midwife 45 Figure 4 Do you feel care given during established labour and birth was ‘one-to-one’? 49 Table 4 One-to-one care by location 49 Figure 5 Delivering one-to-one care – trusts/boards who measure 51 Table 5 One-to-one care in different sites in a Yorkshire trust 52 Figure 6 Calling for attention 54 Table 6 Calling for attention, by location 56 Figure 7 Proportion of women voting for forms of support 57 DECISIONS AND OBStacles - CHOOSING WHERE TO GIVE BIRTH Page Table 1 Number of location options presented to women 62 Figure 1 Options of where to give birth 63 Figure 2 Birth location preference 64 Table 2 Choice of location by primi or multipara status 65 Table 3 Choice of location by options in your area 65 Table 4 Wanting to give birth in an Freestanding Midwifery unit 66 Table 5 Wanting to give birth at home 66 Table 6 Location attributes 67 Support Overdue: Women’s experiences of maternity services – Page 4 LIST OF FIGURES AND TABLES DECISIONS AND OBStacles - CHOOSING WHERE TO GIVE BIRTH CONTINUED Page Figure 3 Different locations - what appeals to women? 68 Table 7 Proportion of low risk women in trusts’/boards’ care 71 Table 8 What happens after you make a choice 73 Table 9 What happens to women’s location choices 74 Figure 4 Where births take place, by region 77 CONTINUING CARE Page Figure 1 Seeing a midwife as much as you wanted to 84 Table 1 Seeing a midwife as much as you wanted to, by region 88 Table 2 Seeing a midwife at a convenient time 88 Figure 2 When women want more support 90 Support Overdue: Women’s experiences of maternity services – Page 5 Foreword FOREWORD “There are chronic shortages of midwives. The NFWI For too many women calls on the government to increase investment in the the early days and training, employment and retention of midwives in England and Wales to ensure services are adequately weeks with a newborn resourced and are able to deliver a high standard of care.” baby are coloured Horwich WI Lancashire Federation, June 2012 by experience of a system that is less than At the 2012 AGM, WI members first-hand how the unique challenges passed a resolution calling for the that our maternity system faces satisfactory. ‘employment of more midwives’. have translated into pressure on the Brought to her WI by a midwife maternity workforce and thus on working in the North West of England, maternity care. the resolution has highlighted an issue that touches so many women across In recent months the NHS has gone the world. It is a call for action on a through an unprecedented period service that is often called the ‘shop- of change. Much has been said and window’ of the NHS; a service that written about the centrality of patient currently sees almost 2,000 women led-care to the reform programme give birth each day and supports over and the commitment to ensuring that 700,000 families annually. people have a positive experience of NHS care. The report we present here The increasing pressure that maternity seeks to describe and analyse the services have faced in recent years experiences of women and families has been well documented. Barely a using NHS maternity services. It month goes by without a news story draws on the insight provided by framework of guidance, we are still detailing the multifaceted challenges members of the WI, the UK’s largest not getting maternity care right, facing maternity services: the baby voluntary organisation for women, leaving too many women with a boom, the increase in more complex and NCT, the UK’s largest parenting poor experience of care and too pregnancies and births from women charity. Alongside these voices it many midwives unable to deliver with higher risk factors, and maternity has made use of official data and the excellent standard of care that units struggling with workforce information to provide a wider they want to. The framework is in numbers that have not kept pace with investigation into levels of care that place and as the NHS moves through the rising birth rate. women in different parts of the UK can a period of major change it will expect to receive. remain important that maternity Resources have been invested in services continue to be a key priority. this area, indeed, midwife numbers The majority of women have an As we mark International Day of increased under both the current and outstanding experience of maternity the Midwife 2013, I hope that the the previous governments. But has care. This should be celebrated. message that ‘the world needs the limited investment that we have Yet at the same time, for too many midwives now more than ever’ is seen to date been enough given the women the early days and weeks being heard by decision-makers.
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